超声定量分析Stanford B型主动脉夹层TEVAR前后肠系膜上动脉血流灌注的临床价值

Clinical value of ultrasound quantitative analysis of superior mesenteric artery perfusion before and after TEVAR in Stanford type B aortic dissection

目的 探讨超声定量分析stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)前后肠系膜上动脉(SMA)血流灌注的临床价值。方法 选取我院首次采用TEVAR治疗的stanford B型主动脉夹层累及肠系膜上动脉的105例患者,TEVAR前3日内及术后1、3、6个月完成主动脉血管造影(CTA)检查,TEVAR前后24 h内完成主动脉超声检查,记录肠系膜上动脉血流参数。依据SMA受累形式分组:动力型缺血:SMA开口于小真腔组。静力型缺血:A组:SMA开口于假腔,开口水平未见再破口;B组:SMA开口于假腔,开口水平可见再破口;C组:SMA开口于假腔,骑跨真假腔;D组:SMA开口于假腔,夹层形成,真腔供血为主;E组:SMA开口于假腔,夹层形成,假腔供血为主。术前术后血流参数比较采用配对t检验。结果 小真腔组、D组术后收缩期峰值(PSV)、血流量(VolFlow)增加,B组术后平均舒张流速(MDV)减少、VolFlow增加,E组术后VolFlow减少,差异均有统计学意义(P<0.05)。结论 超声检查能够监测主动脉夹层所致肠系膜缺血的血流动力学演变进程,为关口前移防治肠系膜灌注不良综合征提供信息。

Objective To assess the clinical value of ultrasound in quantitative analysis of perfusion of superior mesenteric arteries before and after TEVARin Stanford type B aortic.Methods The subjects of this study were 105 patients with superior mesenteric artery involvement in type B aortic dissection treated with TEVAR for the first time at our hospital.Aortic CTA exami‐nation was completed 3 days before and 1,3,6 months after TEVAR.Aortic ultrasound was performed before and 24 hours after TEVAR and blood flow parameters of the superior mesenteric artery were recorded.The groups were divided,according to the type of SMA involvement into Dynamic ischemia,and SMA opening in small real-lumen groups.The details in static ischemia were as follows:as for group A,the SMA opened in the false lumen and no re-entry tears were observed at the level of the open‐ing;for group B,the SMA opening was in the false lumen and the re-entry tear was visible at the level of the opening;for group C,the SMA opened in the false lumen and ridden across the true and false lumen;for group D,the SMA opening was in the false lumen,the dissection was formed and the blood supply was mainly in the true lumen,and with respect togroup E,the SMA open‐ing was in the false lumen,the dissection was formed,and the blood supply was mainly in the false lumen.Pair t-tests were used to compare pre-and post-operative blood flow parameters.Results PSV and VolFlow increased after operation in small true-lumen group and groupD.After TEVAR,MDV decreased and VolFlow increased in Group B,VolFlow decreased in group E.These differences were statistically significant in above comparisons(P<0.05).Conclusion Ultrasound can monitor the hemo‐dynamic evolution of mesenteric ischemia due to aortic dissection and provide information for the prevention and treatment of mesentery malperfusion syndrome.